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Factitious meningitis. Diagnostic error due to nonviable bacteria in commercial lumbar puncture trays

R A Weinstein, F W Bauer, R D Hoffman

    JAMA
    |August 25, 1975
    PubMed

    Insights

    Contaminated cerebrospinal fluid (CSF) specimen tubes can cause false-positive Gram stains, mimicking bacterial meningitis. This contamination necessitates careful evaluation of diagnostic materials to ensure accurate patient care.

    Area of Science:

    • Clinical Microbiology
    • Diagnostic Pathology
    • Infectious Diseases

    Background:

    • A series of five false-positive cerebrospinal fluid (CSF) Gram stains prompted an investigation into potential sources of contamination.
    • The clinical implications of false-positive results in diagnosing serious infections like bacterial meningitis are significant.

    Purpose of the Study:

    • To identify the cause of recurrent false-positive Gram stain results in CSF specimens.
    • To determine if commercial lumbar puncture trays were the source of bacterial contamination.

    Main Methods:

    • Commercial lumbar puncture trays from the implicated lot were tested.
    • Specimen tubes were filled with a test solution and processed similarly to CSF samples.
    • Gram stains were performed on the processed solutions to detect microbial presence.

    Main Results:

    • Nonviable bacteria were detected in specimen tubes from the commercial lumbar puncture trays.
    • Ten out of twelve evaluated tubes, when processed, yielded Gram stains with Gram-negative rods, diplococci, or coccobacilli.
    • A patient initially treated for bacterial meningitis due to a false-positive result.

    Conclusions:

    • Microbial contamination of commercial CSF specimen tubes is a potential source of diagnostic error.
    • Findings from contaminated tubes can simulate early bacterial meningitis, leading to misdiagnosis and inappropriate treatment.
    • Healthcare facilities should be vigilant regarding the sterility of diagnostic supplies to prevent patient harm.

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